Have you ever worked somewhere and your supervisor says, “Just write an order for that.  We always do that to help out the physicians.”

In that situation, you feel like you’ve been put between a rock and a hard place.  Your supervisor is telling you one thing and your gut is saying, “Hey!  Wait a minute!  I don’t have an order.  I don’t have a policy and procedure and the physician is not available for me to ask.”  Your gut tells you that this is something you should not do yet your Supervisor is ordering you to do exactly that.

This is a dilemma in which nurses frequently find themselves.

If you are asked to do something outside of the scope of your practice … trust your gut … don’t do it!  The physician just might not cover you for what you did.

In addition, know your facility’s standing orders which are those that you can adjust medications based on labs and things like that.  But they must be in the actual order or in the policies and procedures.

Taking it upon yourself to adjust or order medications or order labs is improper without the protection of a standing order or a policy and procedure.  This would be called practicing medicine without a license and exceeding your scope of practice.

In addition, as nurses, we know too much.  Sometimes when we have a pain, we are inclined to take a pain medication that we had around for a long time that was prescribed for another purpose or a previous episode of the same event.  This also is considered practicing medicine without a license and exceeding your scope of practice.

It is really important that as nurses, we set the example.  We cannot borrow a pain medication from someone else because we hurt our back.  We have to go through the proper procedures as we are held to a higher standard than the general public and need to go through the same channels that the general public goes through.  When we are sick, we go to the doctor, emergency room or urgent care to get a prescription.

If you are asked to take a drug test and have a positive urine for a medication for which you don’t have a prescription or a medication that has expired or prescribed for another reason, it is very difficult to protect and defend yourself.

When you take an expired medication or one borrowed from someone else, you are self-prescribing and practicing medicine without a license and exceeding the scope of your practice.  It also is considered diversion because the medicine was not prescribed specifically for you or for that reason.  Diversion simply means taking something from where it was supposed to go and moving it to another place.

This is such a big issue in healthcare.

Although you may not feel well, go to the doctor who knows the best way to help you.  In this way, it is documented that everything was properly prescribed.

When you are faced with these difficult ethical dilemmas and you don’t have policies and procedures to support you, stand in your power and tell your supervisor that you do not feel comfortable doing something which is outside the scope of your practice.

Although you may fear you might lose your job, as I often say, you can always get another job but not another license.